Some outside experts agree.
"I don't think people have given up on the big thing," said Len Nichols, an economist at the centrist New America Foundation, adding that Democratic leaders and health industry officials "understand profoundly that our system is unsustainable. . . . If we fail and wait a decade, it will be that much harder."
Administration officials say that they prefer including a public plan in the bill rather than an alternative system of regional or state health care cooperatives. Still, in an effort to gain traction, the administration repeatedly has signaled a willingness to compromise.
In addition, congressional Democrats have ratcheted back their ambitions from the initial 10-year, $1.6 trillion proposal that called for a big Medicaid expansion and generous subsidies to help the uninsured buy coverage. When that bill's price tag set off a furor, Democrats promised to reduce the cost to no more than $1 trillion over 10 years, and Senate Finance Committee members say they're working on a bill that would cost $900 billion.
Some experts point out that shrinking the legislation would create its own problems. Liberals would see it as a betrayal. There also are practical issues. The final legislation is likely to require most people to have insurance. That would be hard to do, however, if the measure doesn't provide sufficient subsidies for lower-income Americans.
If there's no requirement that everyone buy insurance, it would be hard to compel the insurance industry to cover all applicants, even those in bad health. The reason: Insurers probably would end up with a disproportionate number of sick, costly customers.
Besides expanding Medicaid, the plans that are under consideration in the House of Representatives and the Senate would create a new insurance exchange, or marketplace, for people to buy affordable insurance. Many employers would be required either to offer coverage or to finance its cost, while most uninsured individuals would be required to purchase coverage, many with help from the government.
To reduce the size of the bill, political and health care experts said, the Medicaid expansion could be phased in more slowly or have tighter income-eligibility limits. In addition, the availability of premium subsidies could be reduced and key provisions, such as the health insurance exchanges, also could be implemented on a slower timetable. Some say that the final legislation could be cut to $800 billion or less over 10 years.
The August tracking poll by the Kaiser Family Foundation underscores a partisan divide, with 71 percent of Democrats supporting passage of legislation now and 67 percent of Republicans saying that the country can't afford it at this point.
Independents are more divided than before, with 49 percent opposed to legislation now and 46 percent in favor of it. In July, 42 percent of independents were against an overhaul now and 54 percent had favored it.
Overall, a majority — 53 percent — of the public says that now is the right time to pass legislation, compared with 42 percent who say the U.S. can't afford to take on a health care overhaul now.
Kaiser Health News is part of the Kaiser Family Foundation.
(Julie Appleby of Kaiser Health News and William Douglas of McClatchy contributed to this story.)
(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)
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